How to Avoid the Holiday Blues

By Pat Anson, PNN Editor

For many of us, the holiday season wouldn’t be complete without Christmas cookies, jelly donuts, plum pudding, chocolate babka, or even the much-maligned fruit cake.

But if you're prone to depression or have an inflammatory condition, you might want to avoid those sweet treats. Or at least enjoy them in moderation.

New research by clinical psychologists at the University of Kansas suggests that dietary sugars found in many holiday foods can trigger metabolic, inflammatory and neurobiological processes that can lead to insomnia, digestive problems and depression – which all enhance physical pain.

"A large subset of people with depression have high levels of systemic inflammation,” said lead author Stephen Ilardi, PhD, an associate professor of clinical psychology at KU. "When we think about inflammatory disease we think about things like diabetes and rheumatoid arthritis - diseases with a high level of systemic inflammation. We don't normally think about depression being in that category, but it turns out that it really is.

“We also know that inflammatory hormones can directly push the brain into a state of severe depression. So, an inflamed brain is typically a depressed brain. And added sugars have a pro-inflammatory effect on the body and brain."

Depression Causes Sugar Cravings

Dwindling daylight in winter can worsen depression and prompt people to consume more sweets, which provide a temporary emotional lift.

"One common characteristic of winter-onset depression is craving sugar," Ilardi said. "So, we've got up to 30% of the population suffering from at least some symptoms of winter-onset depression, causing them to crave carbs - and now they're constantly confronted with holiday sweets.

"When we consume sweets, they act like a drug. They have an immediate mood-elevating effect, but in high doses they can also have a paradoxical, pernicious longer-term consequence of making mood worse, reducing well-being, elevating inflammation and causing weight gain."

The KU research team analyzed a wide range of studies on the physiological and psychological effects of sugar, including the Women's Health Initiative study, the NIH-AARP Diet and Health Study, and studies of Australian and Chinese soda-drinkers. Their research is published in the journal of Medical Hypotheses.

Ilardi says consuming high amounts of sugar could be as physically and psychologically harmful as drinking too much liquor.

"We have pretty good evidence that one alcoholic drink a day is safe, and it might have beneficial effect for some people," Ilardi said. "Alcohol is basically pure calories, pure energy, non-nutritive and super toxic at high doses. Sugars are very similar."

The average American gets about 14% of their calories from added sugars – the equivalent of 18 teaspoons of sugar each day. Most people know a high-sugar diet can lead to diabetes, obesity and cardiovascular problems.

Another way to look at sugar is to think of it as fuel for bacteria.  

"Our bodies host over 10 trillion microbes and many of them know how to hack into the brain," Ilardi said. "The symbiotic microbial species, the beneficial microbes, basically hack the brain to enhance our well-being. They want us to thrive so they can thrive.

“But there are also some opportunistic species that can be thought of as more purely parasitic - they don't have our best interest in mind at all. Many of those parasitic microbes thrive on added sugars, and they can produce chemicals that push the brain in a state of anxiety and stress and depression. They're also highly inflammatory."

Ilardi recommends eating a minimally processed diet rich in fruits, vegetables, fish and whole grains, while avoiding red meats, refined grains, fructose and other unhealthy foods. As for sugar, the KU researcher urges moderation -- not just during the holidays, but year-round.

New Think Tank Seeks to Reduce Pain and Improve Lives

By Stephen Ziegler, PhD, Guest Columnist

Millions of men, women and children in the United States and around the world are dying of cancer, and some die in severe pain because they have limited or no access to essential palliative medicines. Much of that suffering is avoidable.

Opioids and other palliative medicines are powerful drugs that are deemed essential by the World Health Organization. They provide comfort and relieve suffering at the end of life and for those who face serious medical conditions. Unfortunately, these very same drugs also have the potential for abuse, misuse, overdose and exploitation by the illicit market.

According to the 2017 Lancet Commission Report, governments around the world adopted “overly restrictive legislation” that focused more on preventing abuse than ensuring safe access to essential medicines. The problem is not limited to developing countries. Well-intentioned government policies to reduce opioid prescriptions across the United States have resulted in unintended harms for those who are recovering from painful surgeries or who were functioning well on opioid therapy.

Unfortunately, governments rarely investigate whether the drug control policies they create actually work and whether their policies are effective in preventing abuse while providing access to the drugs for those who need them.

But with your help we can change that.

I am proud to announce the creation of the Center for Effective Regulatory Policy and Safe Access (CERPSA), a new nonprofit think and do tank sponsored by the Colorado Nonprofit Development Center.  

CERPSA is a non-partisan, science-based research organization that focuses on the reduction of human pain and suffering by improving the regulation of - and safe access to - palliative medicines and treatments.  

Our mission is to eliminate unnecessary physical pain and suffering, and to help governments and communities create and maintain effective drug control policies that improve people's lives. We believe that there are good public health reasons for controlling drugs, whether in the form of prescription opioids, antibiotics, or even medical cannabis. We do not seek the elimination of regulation, only its dramatic improvement so that drug control policies can ensure access while at the same time prevent abuse.  

CERPSA represents a bold new effort to help reduce pain and improve people’s lives through research, education and outreach. Now more than ever, we need science-based initiatives that can fundamentally help change the way drugs are controlled.  

You can become part of the movement. Please join us by visiting our website and donating to CERPSA and help us reduce human pain and suffering in the nation and around the world. 

Dr. Ziegler has been trained as both a social scientist and attorney, has been involved in pain treatment and drug policy for almost two decades, and was both a Mayday Pain Scholar and Fellow.

Veteran With Chronic Pain Hospitalized After Vaping THC

By Marlene Harris-Taylor, Ideastream

As vaping has grown more popular in recent years, the trend has been fueled by the habit’s pleasurable allure: Compared with smoking cigarettes or pot, vaping is discreet and less smelly. Vaping fluids come in hundreds of flavors. There’s no tar or other byproducts of burning. And vape pens are high-tech, customizable and sleek.

But none of that mattered to Paul Lubell when he decided to try vaping. He wasn’t thinking about pleasure; he was trying to avoid pain. The retired Navy veteran turned to vaping marijuana, hoping it would help him cope with his chronic, debilitating musculoskeletal pain.

Unfortunately, it wasn’t long before he became part of the national statistics tracking an outbreak of a vaping-related lung illness that has killed more than 50 Americans and sickened 2,400. Lubell ended up in the hospital, seriously ill from vaping an oily liquid containing extracts of THC, the psychoactive ingredient in marijuana.

Lubell, who lives in the Cleveland suburb of Beachwood, is older than most of those who have contracted what is now being called “e-cigarette or vaping associated lung injury,” or EVALI.

Three-quarters of patients with the condition have been under age 35; Lubell is 59.

But like patients in the majority of those cases, he used THC. And the latest information from the Centers for Disease Control and Prevention suggests that it’s some added ingredient in THC vapes — likely vitamin E acetate — that is causing the lung disease. The CDC is warning people to stop vaping altogether, given the risk of lung illness, which puts people who vape to manage pain in a tough position.

‘My Pain Would Be Gone’

Lubell suffers from pain in his back, neck and knees. He is not sure when his problems started, but he wonders if they are related to his days on a Navy helicopter rescue team.

“It was fun. I was indestructible and good at what I did. Everybody wanted me,” he recalled, while looking at photos of his much younger self posing on top of one of the helicopters.

Lubell sometimes jumped out of the helicopter and smacked into the water during training and rescue missions. That could have been the genesis of some of his back pain, he said. Lubell has had two back surgeries, and he also suffers from serious neck pain. Every day is a struggle, he said.

Looking for relief, he has tried many medications, including opioids such as hydrocodone, but that drug is no longer an option. Lubell is a patient at Louis Stokes Cleveland VA Medical Center, and in the wake of the national opioid addiction epidemic, the VA has revised its pain-treatment protocols.

“The VA is not a friend of opioids at all,” Lubell said. “Unless you’re coming out of the hospital for surgery or something like that, they do not give vets opioids.”

“It leaves someone who is in chronic pain in a very tough situation, having to decide how to deal with it,” he added.

Lubell started using an electronic cigarette device paired with prefilled THC cartridges. Medical marijuana is legal in Ohio, as it is in 32 other states, plus the District of Columbia.

“When I say it took away pain — it was almost instantaneous,” he said. “Within the span of 10 minutes, my pain would be gone. … It made me capable of doing my daily activities.”

Lubell described his old vaping cartridges as tiny sticks that screwed on top of the vaping pen. When he inhaled at one end of the pen, it pulled the THC extract and other liquids in the cartridge over a heating element. Vaping was different from when he had smoked marijuana, Lubell said.

“It doesn’t have a stench to it. You could do it out on the streets. It doesn’t have that — what’s the word I’m looking for? — stigma,” he said.

Hospitalized With Cough And Fever

Lubell purchased the THC cartridges from a friend at what he described as a below-market price. A few months later, in July, Lubell started running a very high fever and went to the Cleveland VA Medical Center.

“He had this cough that was persistent. He just looked very, very sick,” recalled Dr. Amy Hise, who was on the team of physicians that treated Lubell.

“He was put on very strong broad-spectrum antibiotics, and yet he continued to have fevers. He continued to feel unwell. He had very flu-like symptoms,” Hise said.

After a few days, Lubell seemed to improve and was released, according to Hise. But then, he grew ill again.

Hise said she was surprised when he came back to the emergency department in late August.

By then, however, she had seen a new alert from the CDC about the vaping illness. Lubell had also seen reports in the media about health problems related to vaping.

“He was forthright that he had been vaping, and indeed what had happened is when he was in the hospital before, he’d stopped vaping,” Hise said. “He stopped for a period of time until he started to feel better. And then he started it up again, and that’s when his lung disease came back.”

The doctors at the VA switched tactics, taking Lubell off antibiotics and starting him on steroids, based on information provided by the CDC. Lubell was soon released and on the road to recovery.

No More Vaping

Even though vaping eased his pain, those two bouts of respiratory sickness were too much. Lubell said he won’t vape again, and his doctor endorsed that decision.

“I think there’s just too much that’s not known about what’s in these products to safely use them,” Hise said.

But Lubell is not alone in having turned to marijuana for pain management. Dr. Melinda Lawrence, a pain management specialist at University Hospitals, said many patients have told her they are trying marijuana to see if it will help.

“That is probably something that I get from patients every day,” Lawrence said. “And it’s not just people who are young, in their 20s. [There are] people in their 80s who are telling me they are looking to try anything to help with their pain.”

Even though some patients say marijuana helps their pain, there is not enough research to prove it’s broadly and reliably effective, Lawrence said.

“Personally, I don’t recommend it for my patients. But maybe after we have more studies, it can be something in the future” she said.

Lubell, who has an Ohio medical marijuana card, is still planning to use marijuana — but he won’t vape it. He turned over his equipment and leftover THC cartridges to health officials for analysis.

This story is part of a partnership that includes ideastream, NPR and Kaiser Health News, a national health policy news service.

FDA Warns of Serious Breathing Problems Caused by Gabapentinoids

By Pat Anson, PNN Editor

The U.S. Food and Drug Administration is warning that serious breathing problems can occur in patients who use gabapentin or pregabalin with opioids or other drugs that depress the central nervous system. The elderly and patients with lung problems are at higher risk when they use the drugs, according to an FDA drug safety communication.

The advisory is the latest in a series of warnings about gabapentinoids, a class of nerve medication increasingly prescribed as an alternative to opioid painkillers. There are growing reports of gabapentinoids being abused or raising the risk of overdose and suicide.

“Reports of gabapentinoid abuse alone, and with opioids, have emerged and there are serious consequences of this co-use, including respiratory depression and increased risk of opioid overdose death,” Douglas Throckmorton, MD, deputy director for Regulatory Programs in the FDA’s Center for Drug Evaluation and Research, said in a statement.

“In response to these concerns, we are requiring updates to labeling of gabapentinoids to include new warnings of potential respiratory depressant effects. We are also requiring the drug manufacturers to conduct clinical trials to further evaluate the abuse potential of gabapentinoids, particularly in combination with opioids, with special attention being given to assessing the respiratory depressant effects.”

Gabapentinoid products include gabapentin, which is marketed under the brand name Neurontin, and pregabalin, which is marketed as Lyrica. Generic versions of the drugs are also available.

Gabapentinoids were originally developed to prevent seizures, but their use has tripled over the past 15 years. The drugs are approved to treat a variety of chronic pain conditions, such as fibromyalgia, neuropathy and shingles. They are also widely prescribed off-label.

According to the FDA, over 13 million people filled a prescription for gabapentin in 2016, while over 2 million patients were prescribed pregabalin. Nearly one in five of those patients were also taking opioids.

“Pairing an opioid with any CNS depressant – a gabapentinoid, benzodiazepine, sedating antidepressant, sedating antipsychotic, antihistamine, or other product – will increase the risk of respiratory depression. Shifting treatment from one CNS depressant to another may pose similar risks,” the FDA said.

A Dozen Deaths

The agency said it received 49 case reports of serious breathing problems in patients taking gabapentinoids, including 12 people who died from respiratory depression. It’s advising doctors, caregivers and patients taking gabapentinoids to be alert for signs of confusion, disorientation, dizziness, sleepiness, slow or shallow breathing, unresponsiveness, or bluish-colored lips, fingers and toes.

A 2018 study by Australian researchers found that gabapentinoids often had side effects such as drowsiness, dizziness and nausea. Another study found that combining gabapentin with opioids significantly raises the risk of dying from an overdose. And a recent analysis of calls to U.S. poison control centers found a significant increase in suicide attempts involving gabapentin.

There have also been increasing reports of gabapentin and pregabalin being abused by illicit drug users, who have learned they can use the medications to heighten the high from heroin, marijuana, cocaine and other substances.

A recent study published in JAMA Internal Medicine found little evidence that gabapentinoids should be used off-label to treat pain and said their effectiveness was often exaggerated by prescribing guidelines. The CDC’s 2016 opioid guideline recommends gabapentin and pregabalin dozens of times as alternatives to opioids, without saying a word about their abuse or side effects.

“Our goal in issuing today’s new safety labeling change requirements is to ensure health care professionals and the public understand the risks associated with gabapentinoids when taken with central nervous system depressants like opioids or by patients with underlying respiratory impairment. However, we do not want to unintentionally increase opioid use by turning prescribers away from this class of pain medications,” Throckmorton said.

Panel Recommends Opioid Guidelines for Acute Pain Conditions

By Pat Anson, PNN Editor 

The National Academies of Sciences, Engineering and Medicine (NASEM) is recommending that new clinical guidelines be developed for the treatment of short-term acute pain to reduce the risk of excess opioid prescribing.  

A 247-page report released by NASEM cites a lack of guidance on the appropriate type, strength and amount of opioid medication that should be prescribed to patients in acute pain, and claims that many patients are sent home with more pills than they need, which can later be misused. 

“Clinicians who prescribe opioids have to balance two distinct goals: relieving a patient’s severe pain, while minimizing the potential public health harms of opioid misuse and the resulting emotional distress to families and communities,” said Bernard Lo, president of the Greenwall Foundation and chair of a NASEM committee that wrote the report.  

The 15-member panel is composed primarily of academic, government and medical professionals. No pain sufferers or patient advocates served on the committee and the report gives no indication they were consulted with.    

NASEM is a private, nonprofit institution that was contracted by the FDA in 2018 to study the treatment of acute pain and develop a framework for new clinical guidelines.

Unlike the CDC’s controversial 2016 opioid guideline, which applies to a broad range of chronic pain conditions, NASEM is recommending that guidelines be developed for specific medical conditions or procedures that result in acute pain lasting less than 90 days. 

High-priority surgical procedures include cesarean (C-section) delivery, total knee replacement and wisdom tooth removal. Acute pain conditions such as low back pain, sickle cell disease, migraines and kidney stones are also considered top priorities for opioid guidelines.  

“There are still too many prescriptions written for opioid analgesics for durations of use longer than are appropriate for the medical need being addressed,” Janet Woodcock MD, Director  of the FDA Center for Drug Evaluation and Research, said in a statement.  

“The FDA’s efforts to address the opioid crisis must focus on encouraging ‘right size’ prescribing of opioid pain medication as well as reducing the number of people unnecessarily exposed to opioids, while ensuring appropriate access to address the medical needs of patients experiencing pain severe enough to warrant treatment with opioids.” 

‘Opioids Commonly Overprescribed’

The CDC guideline was only intended for primary care physicians treating chronic pain, but has been widely implemented throughout the healthcare system by other federal agencies, insurers, states and hospitals. Emergency room physicians are reluctant to prescribe opioids for trauma injuries and some patients recovering from surgery are being treated with Tylenol.    

The NASEM report suggests those efforts haven’t gone far enough. 

“Despite widespread efforts over the last five years to reduce opioid prescribing, opioids are commonly overprescribed for acute pain. In addition, the amount of opioids prescribed for acute pain varies by provider, hospital, and geographical region,” NASEM found. 

The report claims that post-surgical patients consume only half of the opioids prescribed to them, and between 6 percent and 14 percent of patients who receive opioids after surgery or in the emergency room continue to use them six to 12 months later. 

Those claims are at odds with a large Mayo Clinic study found that only about 1% of patients given opioids in emergency rooms went on to long term use. Another large study conducted by Harvard Medical School found less than 1% of patients being treated with opioids for post-surgical pain were later diagnosed with opioid misuse.  

Guidance Gaps

The NASEM report identifies several gaps in current guidelines for acute pain and recommends more research on nonopioid alternatives, outcomes of opioid prescribing on different patient populations, and the amount of opioids prescribed and leftover after treatment. 

As PNN has reported, the CDC is already in the initial stages of updating its 2016 guideline to include recommendations for treating acute pain and how to taper patients safely off opioids. The update likely won’t be completed until late 2021. 

An FDA spokesman described the work of the two agencies as complementary and with similar objectives.   

“We acknowledge the work CDC has taken in developing federal guidelines on pain management and the use of opioids, which are based on expert opinion. Our work seeks to build on that work by generating evidence-based guidelines where needed,” Nathan Arnold said in an email to PNN. 

“The guidelines we generate would be distinct from this corresponding effort by the CDC, in that our effort would be indication-specific, and would be based on prospectively gathered evidence drawn from evaluations of clinical practice and the treatment of pain. Our work could potentially inform drug labelling. These two efforts are highly complementary and serve adjacent goals.” 

One of the co-authors of the CDC guideline is involved in both efforts. Roger Chou, MD, a primary care physician and professor at Oregon Health & Science University School of Medicine, served on the NASEM committee.  Chou is also directing research on three CDC-funded studies on opioid and non-opioid treatments for chronic pain, as well as a fourth study on acute pain treatment. Those studies will be used by CDC to update its current guideline.

Chou recently collaborated with Physicians for Responsible Opioid Prescribing (PROP), an influential anti-opioid activist group that seeks drastic reductions in the use of opioid medication. Chou co-authored an article with PROP President Dr. Jane Ballantyne and PROP board member Dr. Anna Lembke that encourages doctors to taper “every patient receiving long term opioid therapy.”

Valley Fever Spreading in U.S. Southwest

By Barbara Feder Ostrov and Harriet Blair Rowan, California Healthline

Valley fever cases are on the rise in California and across the arid Southwest, and scientists point to climate change and population shifts as possible reasons.

California public health officials documented 7,768 reports of confirmed, suspected and probable new cases of the fungal disease as of Nov. 30, 2019, up 12% from 6,929 in the first 11 months of 2018.

The increase is part of a recent trend in the nation’s Southwest dating to 2014, with outbreaks most prevalent in California and Arizona. Nationally, public health officials reported 14,364 confirmed cases of valley fever in 2017, more than six times the number reported in 1998, according to the U.S. Centers for Disease Control and Prevention.

Valley fever is caused by a Coccidioides fungus that lives in the soil of California’s Central Valley, Arizona and areas of other Southwestern states prone to desert-type conditions.

Animals and people can contract the infection by breathing in dust that contains the microscopic fungus spores. The infection is not transmitted from person to person.

Symptoms can include fatigue, cough, fever, headache, muscle aches or rash. While the majority of people infected experience mild flu-like symptoms or no symptoms at all, as many as 10% develop serious, sometimes long-term lung problems, including pneumonia.

‘I Am So Tired’

PNN columnist and iPain founder Barby Ingle – who lives in Arizona -- came down with valley fever last month. It was originally diagnosed as bacterial pneumonia, but when Barby’s fever, coughing, headache and joint pain persisted for weeks, her doctors ordered another round of tests.

“A CT scan was ordered that showed that it was actually valley fever pneumonia and that it had spread from the right lung to both lungs and lymph nodes,” Barby explained in an email. “I am told it will be up to a year of treatment and that they will do x-rays, CT scans and blood tests monthly, that there will be permanent scars on my lungs, and that it can turn to meningitis and/or can cause death if not treated.

“I am so tired. I feel like someone really big is sitting on my chest. I have learned that when breathing is compromised, the pain I deal with daily has becomes secondary. The brain concentrates on just breathing.”

BARBY INGLE

Barby has been on oxygen therapy since early November and recently started taking anti-fungal medication. Her immune system was already compromised by Reflex Sympathetic Dystrophy (RSD) and other chronic illnesses.  

“I asked my pulmonologist if I should move and she said if you go to another region, you will just get what they have there. It may not be valley fever, but every region has something like this that people with poor immune systems are more susceptible to,” said Barby. “She told me to ride with my car on recirculated air instead of outside fresh air setting. That is most likely where I was exposed.”   

About 200 Americans die from valley fever every year, according to the CDC. Researchers are working to develop a vaccine for both humans and animals.

Federal health officials say the infections likely are underreported because not every state requires public disease reporting for valley fever and because some infected people never develop symptoms or seek medical care.

Dr. Royce Johnson, a valley fever expert, recalls treating about 250 to 300 cases a year when he arrived in rural Kern County in the 1970s. As of Nov. 30 this year, Kern County — now a hot spot for the disease — reported more than 2,700 confirmed, suspected or probable cases, according to the California Department of Public Health.

“This is a major, major health problem, and it’s growing,” said Johnson, medical director of the Valley Fever Institute at Kern Medical in Bakersfield. “The extent of the endemic area is increasing, and the number of cases in the whole Southwest is going up.”

A University of California study examining the financial toll of valley fever on California estimated the direct and indirect lifetime costs of 2017 cases at about $700 million, when considering treatment expenses, lost productivity and mortality.

Researchers attribute the spike in cases to a number of factors. There’s more awareness of the disease because of media coverage and public health campaigns. California has earmarked $2 million for a public awareness campaign, and employers in regions of the state where workers are at higher risk for the disease will be required to educate them about the disease.

Population growth in the American Southwest, where the fungus is endemic, also plays a role, both because of the increased pool of patients and development that disturbs the soil. In Kern County, which reports the majority of California’s cases, the population has grown 65% since 1990.

But the most significant factor may prove to be climate change, which expands the ecosystems where the fungus can flourish. Using climate models, UC-Irvine researchers projected that by 2100 the expanse of areas with hot, dry conditions favored by the fungus could double and the number of valley fever cases could grow by 50%.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Additional content was added by PNN.

Opioids, Off-Label Prescribing and the Road Not Taken

By Lynn Kivell Ashcraft, Guest Columnist

So much of the conversation about the use of opioids and other medications to treat various conditions has made it sound like doctors are doing something wrong when they utilize a treatment in an off-label fashion. 

Off-label prescribing is not a crime. The federal Agency for Healthcare Research and Quality (AHRQ) estimates that 1 in 5, or 20 percent, of all prescriptions are written for off-label use.

In fact, off-label use of a drug often represents the standard of care. The Food and Drug Administration never intended for its drug approval and labeling process to be the sole determining factor in how a drug is to be used in a clinical setting. 

It is left to physicians themselves to determine the ultimate clinical utility of pharmaceuticals, biologicals and medical devices in treating their patients.

Epidural Steroid Injections Are Off-Label

Some off-label use, however, is controversial. Many accepted protocols for treating back and neck pain include the use of epidural steroid injections (ESIs), despite a lack of rigorous supporting clinical evidence. As many as 9 million ESIs are performed in the U.S annually, yet few patients are told the injections are an off-label use of both the medication (corticosteroids) and the route of administration (an injection into the epidural space of the spine).

In 2014, after hearing about serious neurological problems in patients who received ESIs, the FDA required a label warning that injections of corticosteroids into the epidural space may result in rare but serious neurological events, including "loss of vision, stroke, paralysis, and death."  

Anxious not to lose a treatment that they believed in, professional societies of anesthesiologists, pain medicine physicians, rehabilitation specialists, neurosurgeons, surgeons, radiologists and interventional pain specialists wrote guidelines to prevent complications from ESIs that were published in the journal Anesthesiology in 2015. 

A coalition of doctors also formed the Multisociety Pain Workgroup (MPW) to defend the use of ESI’s. The MPW called an AHRQ study “flawed” and “absurd” because its questioned the effectiveness of ESI’s for treating low back pain. It also lobbied unsuccessfully to have the FDA tone down its warning.

Since 2017, according to OpenSecrets.org, the American Society of Interventional Pain Physicians has spent nearly $1.5 million on campaign donations and lobbying — much of defending the use if ESIs.

Where was the same type of outcry from the medical profession defending the use of opioid medication when the 2016 CDC guideline was released? Why have so many doctors stood by silently while insurers, states and the DEA began implementing the guideline as policy?

Lynn Kivell Ashcraft is an analytic software consultant and writer who lives in Arizona. Lynn has lived with chronic intractable pain for almost 30 years and works with Dr. Forest Tennant as part of the Arachnoiditis Research and Education Project. 

How to Recover From a Painful Breakup Caused by Chronic Illness

By Ann Marie Gaudon, PNN Columnist

What no one talks about. Getting “dumped” because you have chronic pain or illness. Let’s talk.

There’s no denying the unbearable emotional pain if someone you love decides they’ve had enough. The reality is that people can be cruel, including people that you never thought had it in them. Here’s a few zingers I’ve been made aware of:

“You’re always in pain and I’m sick of it!”

“I never signed up for this sh*t!”

 “I’m so done looking after you!”

Sound harsh? It is, and it happens. While the breakup might be blindsiding, the reality is that the partner has likely been emotionally disengaged for some time. By the time they say those words, they are essentially over the relationship. However, for the person hearing them, they are likely in the initial stages of grief.

If you’ve seen messy breakups in the movies, you might think the answer is fuzzy pajamas and a litre of chocolate chunk ice cream. This will take more than a visit with Bridget Jones.

MRI brain scans have shown that the withdrawal of romantic love activates the same brain mechanisms that get activated when someone suffering from substance abuse goes through withdrawal. That is powerful pain. This would explain why we can obsess over ex-partners and crave them as if they were a drug we've been deprived of.

How to help yourself? Ensure the thoughts you have about your ex are realistic and balanced. If your memory consistently goes to that “best night of your life,” remember all the other nights that were upsetting to you. If you are consistently longing for their loving embrace, remember the nights that your advances were rejected.

What Went Wrong?

If you’re really struggling to get a grip on the reality of the relationship, write a list of all the reasons that it went south. You will see that it wasn’t 100% due to your pained body.

The point is to take a wider look and get a better perspective on the entire relationship. While you are emotionally depleted, your focus will tend to be narrow and unrealistic.

Accept explanations that fit the facts -- such as they were unwilling to make a commitment or they were not the person you thought they were. Avoid creating a harsh inner critic about why the breakup happened and see the relationship for what it was. Make a list of compromises that you made in this relationship that you would rather not make next time. What did you learn about yourself? Can you grow from this?

Do not check on your ex through social media. This will make it harder for you to stop fantasizing about your relationship and spending your time marinating in self-pity while imagining your ex out there living their best life sans you. Remove reminders of your ex such as photos, emails, or messages which will only add to your distress.   

Take control of your behaviour. Do things that used to bring you joy, even if they don’t at the moment. Continuing to engage is a very important way to tell yourself that life does go on. 

Reach out to friends, family or other loved ones to gather all the support you need. We all know what breakups are like and we all have our own words of wisdom to offer.

If your grief is not lessening with time, reach out to a therapist. A trusted therapeutic relationship can help you find your voice to express your grief in a healthy, healing way. A skilled therapist can also help you to develop new social relationships and a sense of self-worth to help decrease isolation and pain-related depression.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

Poppy Seed Tea: Deadly Potion or Potent Pain Reliever?

By Pat Anson, PNN Editor

You can find poppy seeds in cakes, cookies, muffins and salad dressings. The tiny versatile seed is even used in cosmetic products as a skin moisturizer and exfoliant.

What you may not know is that poppy seeds can also be used to make tea. The bitter homemade brew doesn’t taste good, but some chronic pain sufferers have discovered poppy seed tea is a potent pain reliever.

“This fall I will be growing opium poppies and extracting my own medicine. I did grow a few plants last year and the tea I had made from those poppy pods was extremely helpful,” said Ed, a pain patient in Texas who was taken off opioid medication by his doctor.

“I do know the dangers and illegality of doing this, but a man has to do what a man has to do for relief. I have exhausted every legal option I can think of. There is absolutely no help from the medical community around here.”

Ed is not alone. He and other patients who have lost access to opioid painkillers have learned that unwashed poppy seeds contain opium alkaloids that, when soaked in water, can be converted into morphine and codeine.

It takes hundreds of poppy seeds to brew a single cup, but the seeds can be purchased cheaply in bulk for about $10 a pound from online retailers like Amazon and eBay.

“This means for under $15/week I can be back to being a partially functional human being. I am doing way better than I was on the measly 20mgs of Oxy I had been struggling and stressing to get from the doctors,” said another pain sufferer, who claimed she used poppy seed tea to wean herself off oxycodone.

“Safe if used carefully. Easy to make and drink. You can add things like lemonade to make it taste better.”

DEA Warns About Unwashed Seeds

Poppy seeds make up only a tiny part of the worldwide trade in opium products, most of which comes from Afghanistan. According to The Washington Post, four times as much Afghan land is being used in poppy production today than in 2002, shortly after the U.S. invasion. Afghanistan now produces 82% of the world’s supply of heroin, far more than it did under Taliban rule.

With poppy seeds readily available online, the Drug Enforcement Administration recently closed a loophole that allowed unwashed seeds to be sold legally in the U.S. While the poppy plant has long been classified as an illegal controlled substance, the seeds were exempt because they don’t normally contain opium alkaloids. Whether by accident or design, many seeds become contaminated during harvesting.

“Harvesters, who wish to increase opium alkaloids contents on the poppy seed coats, make cuts in the opium pods before they ripen which allows the latex to seep onto the seed coats. Individuals wishing to extract the opium alkaloid content from unwashed poppy seeds, use the seeds to create a tea, which contains sufficient amounts of alkaloids to produce psychoactive effects,” the DEA said in a little publicized announcement that it was classifying unwashed poppy seeds as a Schedule II controlled substance.

“Unwashed poppy seeds are a danger to the user and their abuse may result in unpredictable outcomes including death when used alone or in combination with other drugs as reported in the scientific literature.”

The scientific literature on poppy seed tea is actually very limited. But one recent study urged policymakers to fix the “murky legal status” of poppy seeds and warn patients about the potential dangers.

“With no legal restrictions and apparent endorsement from reliable brands and trusted websites, patients may have little reason to think this tea is actually a version of morphine,” said lead author Jo Ann LeQuang, Director of Editorial Services for NEMA Research.

“I am happy to see the DEA finally take a stance,” says Madeleine Gates, PhD, an Assistant Professor of Forensic Science in the College of Criminal Justice at Sam Houston State University. “I think the poppy tea problem is just another devastating aspect of the opioid epidemic.”

In a 2017 study, Gates used four brewing methods to test 22 samples of bulk poppy seeds purchased legally on the internet. Her research, published in The Journal of Forensic Science, found that a potentially lethal dose of morphine can be brewed in a moderate amount of tea.

“When I was originally contacted to work on poppy tea, I had honestly never heard of it! Now it’s been so eye opening about the drug use that had flown under the radar for too long,” she said in an email to PNN.

Gates began investigating poppy seed tea after being contacted by the father of a 21-year-old man who died after ingesting home-brewed tea. A dozen similar deaths were cited by the DEA in its warning, but Gates believes there could be many more cases.

“I’ve spoken with physicians who are treating poppy tea addicts. I’ve also been involved in a case of a pregnant woman who naively used poppy tea during pregnancy and upon delivery her infant went into withdrawal,” she said.

“I’m sure there have been other cases that are yet to be reported or that may be overlooked. For those who may be known opioid addicts that would have morphine in their system for a hospital or autopsy toxicology test, the first thought is not to think of poppy tea. For that reason, those intoxications or fatalities wouldn’t necessarily be tied to poppy tea unless there was investigative information to link to the case.”

Poppy Tea Addiction

The Internet is filled with stories about illicit drug users experimenting with poppy seed tea. Some became addicted to the tea and went into withdrawal when they ran out of poppy seeds.

“I never got my seeds in time so the awful opiate withdrawals started. I made it two days until I had to go to hospital for withdrawals. I wanted to die!! It’s soooooo horrible. Never felt this way before,” one user posted on Reddit. “I wish I looked into this god damn tea before I started. Didn’t know the withdrawals were going to make me wanna kill myself. Please don’t get addicted to poppy seed tea. It’s awful addiction hard to stop ruins your life.”

Despite the DEA warning, unwashed poppy seeds are still being sold online. A controversial alternative health website even had a recipe for making poppy tea – since taken down — that came with a stark warning.

“Unfortunately, the abuse of or having insufficient knowledge about this tea has led to a few fatal incidences,” the recipe warns. “If you're planning on trying this tea, it's important that you're aware of your own threshold and sensitivities. It's also imperative that you test each batch of poppy seed tea to make sure that you're not unknowingly ingesting high amounts of the opiate alkaloids.”

Another drawback is that even a small amount of poppy seeds in a muffin or cookie can produce a positive reading for morphine in a drug test. That could result in a patient being dropped by their doctor or a referral to addiction treatment

But for some chronic pain patients, the urge to self-medicate is strong and worth the risk. Many, like Ed in Texas, feel abandoned by a healthcare system that has become paranoid about opioid medication. If doctors won’t treat his pain with a legal drug, then Ed believes he has a right to try whatever substance he wants.

“It is my personal observation that the so called medical ‘profession’ around here is lacking professionalism and is poor at best. At times I feel like a drowning man sinking into a deep pool of despair,” Ed wrote in an email. “It is my opinion that people with chronic pain issues should have the ability to break the cycle of the pain that plagues them. I understand the addictive nature of opiates and I feel that I am a responsible adult.”

Landline More Important Than Cell Phone for Chronically Ill Patients

By Barby Ingle, PNN Columnist

I cannot stress enough the importance of having a traditional landline when people are turning to cell phones or internet-based phone systems (VOIP). In 2018, over half of American households were "wireless only homes."

People are switching for cost and convenience, but many are unaware of what they’re losing when they drop their landline. This is a topic close to my heart, because my own father would still be here with us if he had a working landline the night he passed away.

We see television shows where people use their cell phones to call 911 to report a fire or emergency. The fact is it doesn’t work that simply.

Major limitations are introduced when you call for help from a cell phone or VIOP system, which can leave a chronically ill person or someone in an emergency situation unable to receive help immediately.

As a pain patient whose husband worked outside of our home for years, this is something to know and take steps to remedy before something happens to you.

There are a variety of reasons to keep your landline. One would be quality. A landline gets a clear, reliable connection with virtually no delays or lag times. When I do a radio or podcast interview, they usually ask that I call on a landline. Audio issues on a radio show typically occur when a guest is calling from a cell phone or computer.

Calling 911 for help from an area with a weak wifi or internet signal can cause problems. If they can’t hear you clearly, that can delay getting help to you.  A landline almost always provides clear coverage because of the telephone network infrastructure in place across the USA. You don’t have to rely on spotty tower connections or a slow internet.

Many home alarm systems also use landlines, because even when the electricity goes out, the phone line won't. If the alarm system is hooked up through VOIP or a cell phone, there is no guarantee that the call will go through or the person will understand you.

During last year’s disastrous wildfire in Paradise, California, many cell phones were useless because phone towers were damaged or lost electricity. Residents without landlines couldn’t be warned about the approaching fire and over half of the cell phone calls to 911 failed.

Home Alone? Then Keep Your Landline

Having a landline to call in emergency situations is worth the expense. At an additional cost of about $10-20 a month you can have a basic landline active in your home so that you can call local numbers and emergency numbers such as 911 or 0.  

As a chronically ill person myself, I am home a lot. My cell phone service is not great at our house due to the rural area we live in. We use the traditional landline even for regular calls with our family, friends and of course in emergency situations.  

The biggest reason to have a traditional landline is safety. With a landline, you don’t even need to speak.

As long as you can get the phone off the hook and dial “O” for an operator or 911 for emergency services, they can listen in -- in case you are being robbed and need to be quiet or unable to speak for any reason.  

Another advantage of a landline is that your street address comes up automatically on a 911 operator’s computer screen. They know precisely where you are calling from.

That is not always possible with a cell phone. They may be able to determine what cell phone tower your call is being routed through, but they won’t know your exact location.

Imagine your child trying to call 911 because you are having a seizure or unconscious. If the child is too young to speak or remember your address in an emergency situation, a cell phone might as well be a toy.  

If you can only afford one phone line, make it a traditional landline if you spend most of your time at home due to chronic illness. Chances are when you’re out and about, others will have a cell phone and be able to call emergency services for you.  But when you are home alone, trust me, having a landline can save you time, money and perhaps even a life. This is a fact that my family found out firsthand with the death of our father.  

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website.  

Living with Chronic Pain During the Holiday Season

By Dr. Lynn Webster, PNN Columnist

The holiday season is underway, but that doesn't mean everyone is healthy enough to celebrate. Chronic pain does not take a vacation or even ease up in honor of Christmas, Chanukah, Kwanza or any other holiday.

People who are in unremitting pain will suffer, while others throw themselves into endless rounds of joyous holiday-related activities.

For those in pain, and their caregivers, it may not be possible to participate in shopping, decorating or partying. They may feel disenfranchised, abandoned and hopeless. I have received hundreds of emails from people in pain who feel alone. Their doctors may have abandoned them or been unable to provide medication that can help manage their pain.

Holiday-themed social media posts, movies and television shows make it appear as if everyone is, or should be, happy and productive during the final weeks of the year.

However, the truth is that the holiday season can be stressful for many people, regardless of their health. Financial burdens, overindulging in food and alcohol, and getting too little sleep can take their toll.

Family members and friends may fail to empathize, even when they have fewer distractions and social obligations. During the weeks leading up to the New Year, people in pain may feel even more isolated than usual.

Universal holiday bliss is an illusion for many. Other people may long for the commotion of the season to end, too, so calm and normality can return. If you're finding the season to be something other than a never-ending winter wonderland, you have plenty of company in feeling that it is not.

Ask for What You Need

The holiday season does not require you to pretend that you are not in pain. You do not have to wear a mask of well-being in order to ease the burden of others. It is not your job to fake a positive attitude that you do not feel. Your responsibility is to take care of yourself.

You are not obligated to accept invitations for get-togethers, shop for gifts, or decorate when you are experiencing pain.

While other people may hope that you will put on a brave face, you are not required to fake anything you do not feel. On the contrary, you should be honest about your needs and give others a chance to share part of the holiday season with you.

Do let your loved ones know that you are there, and that you are thinking of them. If mobility is an issue for you, consider inviting a relative or friend to visit you. Be up front about the fact that you could use help with meal preparation and cleanup, sending cards, and the like.  

If there is no opportunity to get together with people you care about, perhaps you can arrange an online chat using Skype or a similar service. Ask the children in your life to participate, too. Even active teenagers and sleepy toddlers may be able to find a few minutes to share quality time with you. 

While you may not be able to participate in all of the holiday season activities, you can experience some of the love and joy you deserve if you prompt others to help. 

Seek Support 

Feeling isolated may be one of the most difficult aspects of living with pain during the holiday season. Consider joining a support group so that you can share your burden with people who understand what you are going through. The U.S. Pain Foundation and the American Chronic Pain Association list support groups online that you might benefit from joining.  

Caregivers fill a role that I have described as everyday saints and unsung heroes. However, even saints and heroes can experience burnout around the holiday season.  

It's especially important at this time of year for caregivers to practice self-care. This may include tapping into a caregiver support group and asking family members and friends to provide a short-term reprieve.  

Empower Yourself 

While you may not be able to invest yourself fully in the holiday season festivities, you still have power to take positive action. Reach out to lawmakers, and ask them to support more humane opioid prescribing policies. Contact your local members of the House of Representatives and Senate. Also, send a letter to the editor of your local newspaper and contact the news departments of your local television and radio stations.  

For many Americans, the holiday season is associated with faith. This is a good opportunity to remember that scientists are working on finding better and safer ways to manage pain. Policymakers are beginning to admit that tapering unwilling patients can cause harm.

There is hope that the New Year will bring us closer to solutions for people with pain. 

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is the author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences. 

Drug Legalization Needs to Consider Drugs That Haven’t Been Invented Yet

By Roger Chriss, PNN Columnist

Drug decriminalization and legalization have become hot topics in the U.S. and around the world. Some states have legalized recreational cannabis and a handful of cities have decriminalized psilocybin, a hallucinogen found in some mushrooms. Countries like Portugal have decriminalized all drugs.

The arguments in favor of legalization seem reasonable, from harm reduction and de-stigmatization to access to a well-regulated supply of substances that people are going to use regardless of whether they are legal or not.

But rarely are questions asked about the drugs that haven’t been invented yet. Debate about legalization usually centers on popular but controversial substances like cannabis, with no mention of novel fentanyl analogs or other new psychoactive substances.

Novel opioids appear on the dark web regularly. For instance, the potent synthetic opiod isotonitazene is now being sold online, even though a team of international researchers said it “represents an imminent danger.”

Public health officials in the U.S. also recently warned about isotonitazene in the journal NPS Discovery, after the drug was identified in blood samples from eight overdoses deaths in Illinois and Indiana.

“Pharmacological data suggest that this group of synthetic opioids have potency similar to or greater than fentanyl based on their structural modifications,” they warned. “The toxicity of isotonitazene has not been extensively studied but recent association with drug user death leads professionals to believe this new synthetic opioid retains the potential to cause widespread harm and is of public health concern.”

Similarly, there are reports on overdoses with cyclopropylfentanyl, a chemical cousin of fentanyl that first appeared in Europe in 2017.

“The constantly growing diversity of NSO (new synthetic opioids) still poses a high risk for drug users and can be a challenging task for clinicians and forensic toxicologists. Clinicians treating opioid overdoses should be aware of the potentially long lasting respiratory depression induced by fentanyl analogs,” German researchers said.

Novel Substances

This problem is not limited to illicitly manufactured fentanyls and other opioids. Novel synthetic cannabinoids also pose risks. Such compounds include JWH-018 and AKB48, both known to be dangerous.

And the world of hallucinogens, amphetamines and other psychoactive substances is evolving, too. Psilocybin can now be harvested from bacteria and over 150 synthetic cathiones-- amphetamine-like psychostimulants -- have been identified in clandestine drug markets.

“Over the past hundred years or so, humankind has learned to synthesize the active chemicals in laboratories and to manipulate chemical structures to invent new drugs—the numbers of which began growing exponentially in the 2010s,” Ben Westoff notes in Fentanyl, Inc.

Further, drug consumption technology is changing rapidly. Just as the hypodermic syringe forever changed the risks of heroin, vaping devices are having similar effects. They allow for high-intensity consumption of nicotine, THC, and other drugs that contain unknown contaminants, as seems to have happened with vitamin E acetate in the recent outbreak of lung illnesses associated with vaping.

Lastly, there are risky interactions that can occur with the use of novel substances. The American Council of Science and Health points to the particularly important issue of drug-drug interactions. The world of street drugs now involves so many adulterants and contaminants that, when combined with novel substances, drug-drug interactions are potentially more dangerous than ever.

Historically, legalization of drugs has not led to a net public health benefit. And that was when “drugs” consisted of plant matter or distilled liquids. Modern technology means we can do much better, which in turn means we may be facing far worse.

The greatest risks arguably come from the drugs that have yet to be invented and the interactions that have not been discovered. Any discussion of full drug legalization needs to consider such possibilities.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

Health Risks of NSAIDs Led to ‘Significant Under-Treatment of Pain’

By Pat Anson, PNN Editor

The opioid crisis has been blamed on a lot of things, everything from pharmaceutical marketing to poor medical education to an epidemic of despair.

Now we can also blame NSAIDs.

A new study by researchers at Boston University School of Public Health (BUSPH) found that a decline in prescriptions for non-opioid analgesics — mostly non-steroidal anti-inflammatory drugs and COX-2 inhibitors -- coincided with a marked increase in opioid prescribing for people with chronic musculoskeletal pain.

Concerns about the cardiovascular side effects of Vioxx and other COX-2 inhibitors first came to light in the early 2000s. More was also being learned about heart disease, strokes and gastrointestinal problems associated with NSAIDs.

"While the opioid epidemic is complex and has many possible causes, our findings suggest that health risks associated with NSAIDs were one factor that led to increased prescribing of opioids," says lead author Dr. Andrew Stokes, assistant professor of global health at BUSPH.

Stokes and his colleagues looked at 1999-2016 prescription data for over 7,200 U.S. adults with back pain, neck pain or arthritis. Increases in opioid prescriptions matched the decrease in prescribing for non-opioid analgesics (predominantly NSAIDs and COX-2 inhibitors) between 2003 and 2006.

"We realized that the point at which increasing opioid prescriptions crossed over with the decrease in non-opioid prescriptions occurred when the cardiovascular risks of COX-2 inhibitors led to rofecoxib (Vioxx) coming off the market. The gastrointestinal risks of NSAIDs were also well-recognized by then,” says senior author Dr. Tuhina Neogi, a professor of epidemiology at BUSPH and Chief of Rheumatology at Boston Medical Center.

“Thus it appeared to us that an increase in opioid prescribing during that time was, at least in part, an unintended consequence of COX-2 inhibitors coming off the market and concerns about NSAID risk.”

‘Unmet Need for Pain Management’

The study, published in JAMA Network Open, also found that growing recognition of the opioid crisis after 2013 led to decreases in opioid and non-opioid analgesic prescriptions for people with chronic musculoskeletal pain, particularly among those with less education and lower socioeconomic status.

"Care is needed to ensure that our response to the opioid crisis does not leave people living with chronic pain behind. The abrupt decline in prescribing to those of low socioeconomic status is concerning given that these same individuals also face the greatest barriers to accessing alternative pain treatments, such as physical therapy," Stokes says.

"There's so much talk now about transitioning people away from opioids. But if that's happening without considering the barriers to non-pharmacologic treatments, there may be a significant problem of under-treatment of pain," adds study co-author Dielle Lundberg, a research fellow at BUSPH.

Between 2013 and 2106, researchers found an 11% decrease in prescriptions for both opioid and non-opioid pain relievers, suggesting a significant amount of pain was going untreated.

“Care is needed to ensure that our response to the opioid crisis does not leave people living with chronic pain behind.”

— Dr. Andrew Stokes

“The fact that the present study was restricted to patients with potential needs for pain management also raises the concerning possibility that an unmet need for pain management has increased over this period. Such a trend would be alarming given evidence that untreated chronic pain may prompt patients with chronic pain to seek out illicit heroin or fentanyl,” researchers concluded.

“In addition, several recent studies based on data from the National Violent Death Reporting System have found a high rate of chronic pain among suicide decedents, and recent research and commentary on opioid discontinuation have suggested that recent increases in the suicide death rate may be linked to changes in pain treatment.”

Backlash Against Nurse Who Mocks Patients for Faking Illness

By Crystal Lindell, PNN Columnist

You may have seen it by now. In a short, 15-second video, a nurse plays herself as well as a patient, who appears to be coughing and having trouble breathing. In the video, the nurse starts dancing and ignoring the patient.

The caption reads: “We know when y’all are faking.”

I have to tell you, it’s infuriating to watch.

I’m also wondering what she thinks would be the motivation to fake a cough. It’s not as though they typically treat coughs with pain medication. Is it because she thinks the patient just wants attention? Is that what’s happening?  

As a chronic pain patient who has been in and out of hospitals and doctor’s offices over the years, it’s my worst nightmare. To have a medical professional ignore me and my very real pain because they think they possess some special power that allows them to know with 100 percent certainty that someone is faking.  

I’m not alone in my outrage. The video inspired a viral hashtag, “PatientsAreNotFaking” with countless people sharing why the video wasn’t just annoying, but also dangerous.

Of course. I have my own stories. Doctors and nurses have brushed me off. There were the countless ER doctors who insisted that my multiple visits for abdominal pain were simply heartburn. One doctor even said to me, “It’s not your gallbladder.” 

It was my gallbladder.  

There was also the nurse who ignored my pleas for help after giving me a shot of pain medication that immediately made me nauseous. She told me to “drink some water” and sent me home instead of giving me an easy anti-nausea shot.

I threw up three times on the drive home and then multiple times for the next 10 hours. It was one of the worst nights of my life.  

And then there was the rheumatologist years ago who so easily could have caught my hypermobile Ehlers Danlos syndrome. I had gone to see him because of my unexplained rib pain, and as he examined me, he moved my leg, looked up and said, “Your knee isn’t supposed to bend that way.” Then he shrugged and told me that nothing was wrong with me.  

It would take four years before I finally got the hEDS diagnosis that explained my daily, debilitating chronic pain. 

But let’s take things one step further. Let’s enter the world of the video. Let’s assume patients are faking. So what? What’s the worst-case scenario? Medical professionals have to, God forbid, check in on a patient? Isn’t that their job anyway? 

This issue especially hits close to home for chronic pain patients. Every medical professional’s worst fear seems to be that they’ll give opioids to someone who just needs them because they’re addicted. And I have to ask, again, so what?  

Here’s the two scenarios if you give someone opioids in that situation: 

1. They aren’t faking and you’re helping someone who’s dealing with legitimate physical pain.

2. You’re giving a safe, controlled supply of opioids to someone who’s suffering from such awful withdrawal that they have resorted to trying to get to pain medication at an ER. Oh no! That might accidentally help someone? The horror!

Yes, giving pain medication to people dealing with addiction could lead to a flood of patients in the ER asking for opioids. Honestly, that’s why I support making hydrocodone OTC. It would keep people who are dealing with minor pain out of the ER, as well as those dealing with addiction and withdrawal. It might also prevent many of the overdoses caused by people buying counterfeit drugs off the street. 

The thing is, it’s human nature to assume someone is faking. It’s actually a defense mechanism. Medical professionals see so many sick people in their work that for many the only way they can cope is to convince themselves that most of them are probably faking. It’s much easier to believe that than it is to believe that so many people are suffering.  

The other issue is that people’s instincts are awful. They are often based on subconscious prejudice that they may not even realize is a factor. It’s human nature to separate yourself from other groups as a form of self-preservation. Unfortunately, that leads to a lot of medical professionals assuming that any patient complaining of pain is probably faking it. 

The fact that the nurse who made this particular video, Danyelle Solie, did nothing but double down when faced with criticism shows how poorly-matched she is her for job.  Solie told a Canadian website she’s worked in healthcare for five years.

“I absolutely will not be bullied into apologising or deleting a video because some people disagree with me,” she said in a Tweet thread. “Humor has always been what made me stand out to the people I work with and the patients I help.”

Solie regularly posts comical videos online using the name “D Rose.” Some videos make fun of herself and others make fun of patients or the healthcare system in general. The one about patients faking has been viewed about 15 million times. 

We should expect more from medical professionals. They should be able to wade past their subconscious instincts and make an effort to treat patients fairly. They also shouldn’t joke about such dangerous things.  

And when in doubt? Here’s some advice to all the medical professionals out there: Just assume the patient is telling the truth. Trust me, it’s what you’ll want when you get sick.  

Crystal Lindell is a journalist who lives in Illinois. She eats too much Taco Bell, drinks too much espresso, and spends too much time looking for the perfect pink lipstick. She has hypermobile EDS.  

U.S. Facing ‘Syndemic’ of Opioid Overdoses

By Pat Anson, PNN Editor

The U.S. opioid crisis is a lot more complex than many people think. Instead of a single “epidemic” fueled by prescription opioids, researchers say there are three types of opioid epidemics occurring in different parts of the country simultaneously.

A team of researchers at Iowa State University studied death certificate data from all 3,079 counties in the lower 48 states and found distinct regional differences in the opioids that caused the most overdoses.

Cities in New England have been hit hard by illicit fentanyl and other synthetic opioids; the Rockies and Midwest are plagued by heroin; and a prescription opioid epidemic still lingers in many rural counties in the South and West.

A fourth epidemic – dubbed a “syndemic” by researchers – involves multiple drugs and exists in counties where the opioid crisis first erupted, particularly in mid-sized cities in Kentucky, Ohio and West Virginia. 

About 25 percent of all U.S. counties fall into one of these epidemic categories.   

“Our results show that it’s more helpful to think of the problem as several epidemics occurring at the same time rather than just one,” said co-author David Peters, PhD, an associate professor of sociology at Iowa State University. “And they occur in different regions of the country, so there’s no single policy response that’s going to address all of these epidemics. There needs to be multiple sets of policies to address these distinct challenges.”

LEADING CAUSE OF OPIOID OVERDOSES

Overdose deaths linked to prescription opioids peaked nationwide in 2013 and have fallen in recent years. But researchers say some counties with poor economies continue to struggle with prescription drugs. Over one-third of the counties in Tennessee, Oklahoma, Nevada and Utah fall into this category.

“We find that prescription-related epidemic counties, whether rural or urban, have been ‘left behind’ the rest of the nation. These communities are less populated and more remote, older and mostly white, have a history of drug abuse, and are former farm and factory communities that have been in decline since the 1990s. Overdoses in these places exemplify the ‘deaths of despair’ narrative,” researchers reported in the journal Rural Sociology.

“By contrast, heroin and opioid syndemic counties tend to be more urban, connected to interstates, ethnically diverse, and in general more economically secure. The urban opioid crisis follows the path of previous drug epidemics, affecting a disadvantaged subpopulation that has been left behind rather than the entire community.” 

The study found heroin overdose deaths clustered along two major corridors, one linking El Paso to Denver and another linking Texas and Chicago. Those findings correspond with known drug routes used by cartels smuggling heroin into the U.S. from Mexico.

The study only looked at death certificate data up to 2016, missing the full impact of the CDC opioid guideline, as well as the widening scope of the fentanyl and counterfeit drug crisis. As PNN has reported, hundreds of people have died on the west coast this year after ingesting counterfeit oxycodone laced with fentanyl.

“We are waiting to obtain the 2017 and 2018 data from CDC, but I expect the number of Rx opioid epidemic counties have transitioned to the synthetic+Rx epidemic and the opioid syndemic,” Peters told PNN in an email. “Fentanyl mixtures are replacing Rx pills and heroin in many places, mainly because fentanyl analogs are cheap to produce and generate more profits for drug traffickers.”

Given the expanding nature of the opioid crisis, Peters and his colleagues say tighter regulation of opioid prescribing and dispensing will have little effect on overdoses. The same is true for law enforcement efforts to stop drug traffickers and smuggling.

Instead they recommend expanding access to addiction treatment, as well as long-term investment in struggling communities to reduce both economic despair and the demand for drugs.